Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Following heart care guidelines saves lives

11.11.2004


The closer hospitals adhere to national guidelines for treating potential heart attack patients, the greater the decline in their mortality rates, according to a analysis of treatment patterns at 315 U.S. hospitals by Duke Clinical Research Institute researchers.



The analysis is among the first of its kind to definitively link hospital’s improvement in use of guideline-recommended treatments with concomitant reductions in hospital death rates. These findings should provide compelling scientific evidence that quality improvement initiatives are worth it, and translate into significant savings in patients’ lives, the researchers said. "These findings should be a strong motivation to people, who until now found it difficult to commit to quality improvement initiatives without evidence that they work," said cardiologist Eric Peterson, M.D., who presented the results of the Duke analysis Nov. 10, 2004, at the annual scientific sessions of American Heart Association (AHA) in New Orleans. "This study shows what a profound influence quality improvement can have on saving patients lives."

The study involved analyzing reports of hospitals’ adherence to treatment guidelines and mortality rates over a two-year period, from 2002 to 2003. "When we looked at the hospitals as a group at the beginning, they were almost indistinguishable from each other in their capabilities and services offered," said Peterson "The only difference was that over time some changed their practices according to the guidelines and others did not. "However, when we then looked at how mortality rates changed from baseline to the latest quarter, what we found was remarkable," he continued. "Those hospitals that were the worst at following the guidelines saw their mortality rates increase, while those hospitals that had the largest improvement in adherence had the greatest decrease in mortality rates. We believe this is the best argument for hospitals to devote the necessary time and effort into improving their systems for taking care of these patients."


Specifically, overtime, the mortality risks rose by 3.1 percent at hospitals whose care had worsened. In contrast, mortality risks declined by 37 percent over the same time period among hospitals whose care patterns were most improved. Both the American College of Cardiology and the AHA have issued guidelines for optimal care of patients who arrive at hospital with symptoms of a possible heart attack, such as chest pain (unstable angina), irregular readings on an electrocardiograph or elevated chemical markers of cell death.

The guidelines, adopted after large-scale clinical trials demonstrated the effectiveness of specific therapies in saving lives, focus on giving suspected heart attack patients anti-platelet medications, heparin, glycoprotein IIb/IIIa inhibitors (clot inhibitors) or beta-blockers within the first 24 hours of admission. The guidelines also call for prescribing such drugs as aspirin, beta-blockers, ACE inhibitors or statins after discharge.

For the analysis, Peterson drew on the database of a national quality improvement initiative known as CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC and AHA Guidelines). CRUSADE maintains a national registry of data collected from more than 400 hospitals nationwide and then reports back to each hospital every three months on their adherence to the guidelines.

The current analysis focused on the quarterly changes in guideline adherence and mortality rate changes at 315 hospitals from all of 2002 through September of 2003. During that period, a total of 21,588 patients had been treated. The hospitals were then divided into quartiles based on the degree to which they adhered to the guidelines. Each hospital was characterized as either: process worsening, no improvement, modest improvement or large improvement.

Altogether, adherence to the guidelines by the hospitals in the study improved from 67.9 percent to 77.3 percent during the study period. Over the course of analysis, the hospitals termed process-worsening had a negative 4.6 percent adherence to the guidelines and an average 3.1 percent increase in mortality. On the other end of the spectrum, the hospitals with the largest improvement had a 15.6 percent increase in adherence and a 37 percent decline in death rates.

The next step, according to Peterson, is to better understand the particular reasons behind each hospital’s inability to implement quality improvement initiatives. "Just because a hospital is participating in a program like CRUSADE is insufficient alone in making a change for the better," Peterson said. "We will be conducting in-depth interviews at different hospitals to characterize why some are refractory to change, with a goal of helping them get better."

Richard Merritt | EurekAlert!
Further information:
http://www.duke.edu

More articles from Health and Medicine:

nachricht Researchers identify new way to unmask melanoma cells to the immune system
17.01.2018 | Duke University Medical Center

nachricht Study advances gene therapy for glaucoma
17.01.2018 | University of Wisconsin-Madison

All articles from Health and Medicine >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Scientists decipher key principle behind reaction of metalloenzymes

So-called pre-distorted states accelerate photochemical reactions too

What enables electrons to be transferred swiftly, for example during photosynthesis? An interdisciplinary team of researchers has worked out the details of how...

Im Focus: The first precise measurement of a single molecule's effective charge

For the first time, scientists have precisely measured the effective electrical charge of a single molecule in solution. This fundamental insight of an SNSF Professor could also pave the way for future medical diagnostics.

Electrical charge is one of the key properties that allows molecules to interact. Life itself depends on this phenomenon: many biological processes involve...

Im Focus: Paradigm shift in Paris: Encouraging an holistic view of laser machining

At the JEC World Composite Show in Paris in March 2018, the Fraunhofer Institute for Laser Technology ILT will be focusing on the latest trends and innovations in laser machining of composites. Among other things, researchers at the booth shared with the Aachen Center for Integrative Lightweight Production (AZL) will demonstrate how lasers can be used for joining, structuring, cutting and drilling composite materials.

No other industry has attracted as much public attention to composite materials as the automotive industry, which along with the aerospace industry is a driver...

Im Focus: Room-temperature multiferroic thin films and their properties

Scientists at Tokyo Institute of Technology (Tokyo Tech) and Tohoku University have developed high-quality GFO epitaxial films and systematically investigated their ferroelectric and ferromagnetic properties. They also demonstrated the room-temperature magnetocapacitance effects of these GFO thin films.

Multiferroic materials show magnetically driven ferroelectricity. They are attracting increasing attention because of their fascinating properties such as...

Im Focus: A thermometer for the oceans

Measurement of noble gases in Antarctic ice cores

The oceans are the largest global heat reservoir. As a result of man-made global warming, the temperature in the global climate system increases; around 90% of...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

10th International Symposium: “Advanced Battery Power – Kraftwerk Batterie” Münster, 10-11 April 2018

08.01.2018 | Event News

See, understand and experience the work of the future

11.12.2017 | Event News

Innovative strategies to tackle parasitic worms

08.12.2017 | Event News

 
Latest News

Polymers Based on Boron?

18.01.2018 | Life Sciences

Bioengineered soft microfibers improve T-cell production

18.01.2018 | Life Sciences

World’s oldest known oxygen oasis discovered

18.01.2018 | Earth Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>